Aminoglutethimide in advanced breast cancer: clinical results of a French multicenter randomized trial comparing 500 mg and 1 g/day

We have conducted a multicenter randomized clinical trial comparing in advanced post-menopausal breast cancer patients 500 mg vs 1 g AG/day. The hydrocortisone dose was 40 mg/day in both groups. One hundred and seventy patients have been randomized; 161 were evaluable for tolerability, 149 for effectiveness. Response rates were similar in both groups, 19 and 24% respectively for the 500 mg and 1 g groups. No difference was observed according to tumor site. Duration of response was the same in both groups (14 months), as was mean time to response (about 3 months). Survival (studies in 125 patients) was similar in both groups (responders and non-responders). No response could be obtained with 1 g after relapse or failure with 500 mg (n = 17). Tolerability was good in 91% of the 500 mg group patients and 78% of the 1 g group patients (P less than 0.03). It was poor in 4 and 15% respectively (P less than 0.03). Side-effects were the same in both groups but less frequent and less severe in the 500 mg group; however, these patients more frequently had 'moon face'.

Aminoglutethimide-induced hematologic toxicity: worldwide experience

Marked leukopenia and/or thrombocytopenia occurred in 12 of 1333 patients treated with aminoglutethimide (0.9% incidence). Depression of blood cell counts was evident within 7 weeks of starting treatment. No delayed toxicity was encountered. Blood cell counts recovered promptly upon cessation of aminoglutethimide in all but one patient, who died from septicemia and marrow aplasia.

[Aminoglutethimide in the treatment of advanced prostatic cancer]

A total of ten previously castrated men with stage D carcinoma received 1000 mg aminoglutethimide and 50 mg/die cortisoneacetate. The patients were evaluated using the criteria of the National Prostate Cancer Project. No patients showed objective response, three patients had reduction of bone pain and subjective improvement. Pretreatment testosterone, prolactine and estradiol levels were measured. Three patients had a statistically significant elevation of testosterone levels.

[Panmyelopathy induced by aminoglutethimide. Report of a clinical case]

Aminoglutethimide inhibits the synthesis of oestrogens in adrenal and non-adrenal tissues and can be successfully used in the treatment of advanced breast cancer. In this article, a case with aplastic anaemia, a rare but severe side effect of aminoglutethimide is reported.

Pros and cons of aminoglutethimide for advanced postmenopausal breast cancer

In a phase II clinical trial, 38 postmenopausal women with advanced breast cancer were treated with aminoglutethimide and replacement hydrocortisone. All women had previously received up to 4 modalities of endocrine therapy. Seventeen patients had also been treated with cytostatic drugs. Twenty-five percent of the 29 evaluable patients experienced objective tumor regression, lasting from 11 to more than 18 months. In 29% the disease was stabilized for 3 to more than 15 months. Toxicity was significant, necessitating drug withdrawal in 3 patients. One patient died within 3 weeks of therapy from multiple perforated gastric ulcers. Two patients developed herpes zoster within 4 weeks of treatment. Many side effects were minor and transient. However, treatment resulted in overt primary hypothyroidism in 25% of the evaluable patients and in a strongly increased need of acenocoumarin in all 3 patients on anticoagulant therapy.

Response to aminoglutethimide and cortisone acetate in advanced prostatic cancer

Forty patients with metastatic adenocarcinoma of the prostate were evaluated for response to treatment with aminoglutethimide plus cortisone acetate. All had relapsed from or failed to respond to primary endocrine treatment with orchidectomy or stilboestrol. Nineteen patients (48%) showed subjective response, in most cases relief of bone pain. Side effects limited treatment in only 3 patients. We conclude that aminoglutethimide plus cortisone acetate is a useful addition to the treatment available for this difficult group of patients. The mechanism by which this treatment has a beneficial effect remains unclear.

Aminoglutethimide-induced bone marrow injury. Report of a case and review of the literature

A patient with advanced breast cancer who died of septicemia associated with aminoglutethimide induced agranulocytosis, is reported. Aminoglutethimide is effective and widely used in the treatment of metastatic adenocarcinoma of breast. Thrombocytopenia, leukopenia, or pancytopenia have been reported as complications of therapy in 1.6% of 1345 patients treated in recently published clinical trials employing aminoglutethimide; and this may underestimate the true incidence of this drug side effect. Implications for clinical research and clinical practice are discussed.

Low-dose aminoglutethimide in treatment of advanced breast cancer

The clinical and endocrine effects of low-dose aminoglutethimide without hydrocortisone in patients with advanced breast cancer were investigated. In a dose escalation study low-dose aminoglutethimide alone (62.5-125 mg twice daily) was as effective as conventional doses with hydrocortisone in lowering serum oestrone and oestradiol concentrations but caused minimum adrenal inhibition, as assessed by serum dehydroepiandrosterone sulphate. 11 of 57 (19%) evaluable patients had tumour regression by objective criteria on this treatment, but the frequency of side-effects was similar to that with conventional doses. Low-dose aminoglutethimide is active in the treatment of breast cancer. It appears to work by inhibition of the aromatase enzyme system in peripheral tissues rather than adrenal suppression.

Treatment of disseminated breast cancer with tamoxifen, aminoglutethimide, hydrocortisone, and danazol, used in combination or sequentially

222 patients with disseminated breast cancer have been randomised to receive either a combination of hormone therapies using tamoxifen, aminoglutethimide with hydrocortisone, and danazol (TAD), or tamoxifen alone. The response to the combination was significantly better (43%) than that to tamoxifen alone (31%). Patients who relapsed after response or failed to respond to tamoxifen were subsequently treated with aminoglutethimide and then, if possible, with danazol. Some patients who received TAD were subsequently treated with alternative endocrine therapy, which was usually medroxyprogesterone acetate. Of the 111 patients who initially received tamoxifen, 43 responded to the tamoxifen and/or subsequent endocrine therapy. Of the 111 patients who initially received TAD, 50 responded. Although the duration of response to TAD was the same as for tamoxifen, the TAD patients achieved remission more quickly. The total time in endocrine remission for patients receiving TAD is 303 months to date, compared with 264 months for patients receiving tamoxifen. Survival for patients randomised to receive TAD or tamoxifen is the same.

Clinical effect of aminoglutethimide, medical adrenalectomy, in treatment of 43 patients with advanced prostatic carcinoma

The initial treatment of patients with Stage D prostatic carcinoma with orchiectomy or estrogens is successful in giving objective and subjective improvement for variable periods of time. However, after initial endocrine treatment patients generally relapse, and go on to further progression of their disease. However, a subgroup of approximately 22% of these Stage D prostatic cancer patients respond to either surgical adrenalectomy or hypophysectomy, indicating some degree of continued hormonal responsiveness. Forty-three previously castrated patients with Stage D prostatic carcinoma were treated with 1000 mg of aminoglutethimide and 40 mg of hydrocortisone daily and have been evaluated using the criteria of the National Prostatic Cancer Project. Progression of disease after initial hormonal therapy has varied from 3 to 25 months. One patient has had a complete response, and continues in remission after 290 weeks of therapy. Partial objective responses have been observed in 6 patients, and 10 patients have remained objectively stable for an average of 35 weeks in this latter group.

Aminoglutethimide-induced leukopenia: a case report and review of the literature

A 67-year-old patient with breast carcinoma on treatment with aminoglutethimide (AG) developed profound leukopenia and sepsis. WBC count recovered within 1 week and the drug was renewed without further complications. The hematological toxicity of AG is reviewed. Detailed descriptions of this side effect of AG are usually lacking in most published series. It appears though that blood dyscrasia due to AG occurs rarely and is promptly reversible upon discontinuation of the drug, but renewal of its administration is not always possible.

Treatment of breast carcinoma with aminoglutethimide

During the past three years 52 patients (51 females and 1 male) have been treated for advanced carcinoma of the breast with aminoglutethimide (AG) with addition of a glucocorticoid. More than half of the patients had received three or more systemic treatments and at least two different endocrine regimens before the start of the AG therapy. All patients had previously been treated with tamoxifen. The treatment had to be discontinued after less than six weeks in 2 patients due to acute toxicity and in 4 patients due to intercurrent disease. Fifteen out of the 52 patients had an objective response; 4 complete responders were noted. In addition, the disease remained stable for 2 to 19 months in 16 patients. Aminoglutethimide in combination with a glucocorticoid seems to be an efficient treatment as a late endocrine alternative in a sequence of different endocrine regimens.